CLINICAL SPECTRUM OF SOLITARY RECTAL ULCER IN CHILDREN PRESENTING WITH PER-RECTAL BLEED

Authors

  • Muhammad Nadeem Anjum The Children's Hospital & The Institute of Child Health, Lahore.
  • Huma Arshad Cheema The Children's Hospital & The Institute of Child Health, Lahore.
  • Hassan Suleman Malik The Children's Hospital & The Institute of Child Health, Lahore.
  • Muhammad Almas Hashmi The Children's Hospital & The Institute of Child Health, Lahore.

Abstract

Background: Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less common in children. The objective of this study was to determine the frequency and clinical spectrum of solitary rectal ulcer in children with bleeding per rectum. Methods: This study was conducted in the Department of Paediatric Gastroenterology Hepatology& Nutrition; The Children’s Hospital &The Institute of Child Health, Lahore, from January–December 2015. Total 187 children presenting with per-rectal bleeding who underwent colonoscopy were entered in the study. Demographic and presenting clinical features; colonoscopy and histopathology findings were recorded. Data was analysed using SPSS-20. Results: Out of a total of 187 children with bleeding per rectum, 21 (11.23%) were diagnosed with solitary rectal ulcer. Males were 15 (71.43%) and females were 6 (28.57%) with age range 8–12 years. Mucus in stool 14 (66.7%), constipation 12 (57.1%) and tenesmus 10 (47.6%) were the most common clinical presentations. Colonoscopic finding are solitary erythmatous ulcerative lesion was seen in 8 (38.09%) children, multiple ulcerative lesions in colon 6(28.57%), multiple ulcerative lesions in rectum 5 (23.81%), polypoidal growth in colon and hyperaemic rectal mucosa in 1 (4.76%) each. Histopathological findings were consistent with SRUS in all the cases. Conclusion: The frequency of SRUS was high (19.6%) in patients with per-rectal bleed. Mucus in stool, constipation and tenesmus were the most common clinical presentations. Colonoscopic and histopathological findings were helpful in the confirmation of the underlying aetiology.Keywords: Solitary Rectal Ulcer Syndrome; Bleeding per Rectum; Constipation; Tenesmus

Author Biographies

Muhammad Nadeem Anjum, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

Huma Arshad Cheema, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

Hassan Suleman Malik, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

Muhammad Almas Hashmi, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

References

Pant C, Sankararaman S, Deshpande A, Olyaee M, Anderson MP, Sferra TJ. Gastrointestinal bleeding in hospitalized children in the United States. Curr Med Res Opin 2014;30(6):1065–9.

Keshtgar AS. Solitary rectal ulcer syndrome in children. Eur J Gastroenterol Hepatol 2008;20(2):89–92.

Perito ER, Mileti E, Dalal DH, Cho SJ, Ferrell LD, McCracken M, et al. Solitary rectal ulcer syndrome in children and adolescents. J Pediatr Gastroenterol Nutr 2012;54(2):266–70.

Al-Brahim N, Al-Awadhi N, Al-Enezi S, Alsurayei S, Ahmad M. Solitary rectal ulcer syndrome: a clinicopathological study of 13 cases. Saudi J Gastroenterol 2009;15(3):188–92.

Zhu QC, Shen RR, Qin HL, Wang Y. Solitary rectal ulcer syndrome: clinical features, pathophysiology, diagnosis and treatment strategies. World J Gastroenterol 2014;20(3):738–44.

Dehghani SM, Haghighat M, Imanieh MH, Geramizadeh B. Solitary rectal ulcer syndrome in children: a prospective study of cases from southern Iran. Eur J Gastroenterol Hepatol 2008;20(2):93–5.

Chiang JM, Changchien CR, Chen JR. Solitary rectal ulcer syndrome: an endoscopic and histological presentation and literature review. Int J Colorectal Dis 2006;21(4):348–56.

Esmaeily H. Histopathological misdiagnosis of solitary rectal ulcer syndrome. Res J Biol Sci 2008;3:1171–7.

Crespo Perez L, Moreira Vicent V, Redondo Verge C, Lopez San Roman A, Milicua Salamero J. The three- lie disease: Solitary rectal ulcer syndrome. Rev Esp Enferm Dig 2007;99(11):663–6.

Suresh N, Ganesh R, Sathiyasekaran M. Solitary rectal ulcer syndrome: a case series. Indian Pediatr 2010;47(12):1059–61.

Abid S, Khawaja A, Bhimani SA, Ahmad Z, Hamid S, Jafri W. The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. BMC Gastroenterol 2012;12:72.

Urgancı N, Kalyoncu D, Eken KG. Solitary rectal ulcer syndrome in children: a report of six cases. Gut Liver 2013;7(6):752–5.

Perito ER, Mileti E, Dalal DH, Cho SJ, Ferrell LD, McCracken M, et al. Solitary rectal ulcer syndrome in children and adolescents. J Pediatr Gastroenterol Nutr 2012;54(2):266–70.

Abbasi A, Bhutto AR, Taj A, Aurangzaib, Baloch A, Masroor M, et al. Solitary Rectal Ulcer Syndrome: Demographic, Clinical, Endoscopic and Histological Panorama. J Coll Physicians Surg Pak 2015;25(12):867–9.

Yazdanpanah K, Shavakhi A, Sanei MH, Pezeshki AH, Sarrami AH. An unusual endoscopic presentation of solitary rectal ulcer syndrome. Indian J Gastroenterol 2013;32(1):58–9.

Sharma M, Somani P, Patil A, Kumar A, Shastri C. Endoscopic ultrasonography of solitary rectal ulcer syndrome. Endoscopy 2016;48(Suppl 1):E76–7.

Bishop PR, Nowicki MJ. Nonsurgical Therapy for Solitary Rectal Ulcer Syndrome. Curr Treat Options Gastroenterol 2002;5(3):215–23.

Dehghani SM, Malekpour A, Haghighat M. Solitary rectal ulcer syndrome in children: a literature review. World J Gastroenterol 2012;18(45):6541–5.

Published

2017-01-25

Issue

Vol. 29 No. 1 (2017): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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